Board of Dental Examiners INITIAL Applications Dental Applications Dental License Application #08-4159, Revised 02/13/2025 Dental Specialty License Application #08-4863, Revised 09/28/2023 Permit to Administer Moderate or Minimal Sedation Application #08-4172, Revised 03/03/2025 Permit to Administer Deep Sedation or General Anesthesia Application #08-4618, Revised 03/03/2025 Dentist or Dental Hygienist Courtesy License Application #08-0005, Revised 11/13/2023 Notification of Sedation Agreement #08-4749, Revised 03/03/2025 Temporary Dental Permit Application #08-4789, Revised 11/13/2023 Request for Extension of Temporary Dental Permit #08-4858, Revised 11/13/2023 Hygienist Applications Dental Hygiene License Application #08-0075, Revised 02/13/2025 Dental Hygienist Advanced Practice Permit Application #08-4860, Revised 02/13/2025 Certificate to Administer Local Anesthetic Agent Application #08-0073, Revised 04/04/2023 Dental Hygiene Restorative Function Endorsement Application #08-4567, Revised 04/04/2023 Dental Hygiene Collaborative Agreement Application #08-4542, Revised 04/04/2023 Dentist or Dental Hygienist Courtesy License Application #08-0005, Revised 11/13/2023 Dental Hygiene Nitrous Oxide Certificate Application #08-4748, Revised 04/04/2023 Dental Assistant Applications Certification to Perform Coronal Polishing #08-4561, Revised 04/04/2023 Certification to Perform Restorative Functions #08-4577, Revised 04/04/2023 RENEWAL Applications Dental License Renewal #08-4132, Revised 12/23/2024 Dental Hygiene License Renewal #08-4063, Revised 12/23/2024 Dental Hygiene Restorative Function Endorsement Renewal #08-4609, Revised 02/05/2025 Dental Assistant Coronal Polishing Certification Renewal #08-4610, Revised 12/23/2024 Dental Assistant Restorative Function Certification Renewal #08-4784, Revised 12/23/2024 Moderate or Minimal Sedation Permit Renewal #08-4780, Revised 01/08/2025 Deep Sedation or General Anesthesia Permit Renewal #08-4781, Revised 01/08/2025 Dental Hygienist Advanced Practice Permit Renewal #08-4963, Revised 02/05/2025 Miscellaneous Forms Sedation Checklist for the Dental Office#08-4775, Revised 03/03/2025 Continuing Education Course Approval Application #08-4241, Revised 03/03/2025 Coronal Polishing Course Approval Application#08-4762, Revised 03/03/2025 Nitrous Oxide Course Approval Application#08-4774, Revised 03/03/2025 Restorative Function Course Approval Application#08-4936, New 09/27/2024 Dental or Dental Hygiene Clinical Program Approval Application#08-4608, Revised 03/03/2025 Division forms may be found in the CBPL Quick links, located in the sidebar to the right. Click Here to Renew Online